Dr S Ghoshal*, Dr S Chakraborty, Dr A Sankar, Dr V M Patil, Mr A S Oinam, Dr S C Sharma

Mean age 53 years (35 ­ 70 yrs) Site Distribution Stage Distribution

25 males (80%)
SIB­IMRT allows:
• Dose escalation to the target 77% had stage IVA disease
• Dosimetric sparing of normal tissues 2 failed to complete Rx
Good clinical results in western countries 7 patients reqd gap (Max 14
Data in developing countries limited days)

Grade III Pain seen in 4 (13%)

Feasibility study of Simultaneous Integrated • Median duration: 57 days
Boost IMRT (SIB­IMRT). Grade II Cough in 2 (6%)
SIB­IMRT used to treat 31 patients : • Median duration: 36 days
• Squamous Cell Carcinoma Grade III Dysphagia in 3 (10%)
• Oropharyngeal/ Laryngopharyngeal primary
Incidence of mucositis in the two
• Median duration: 57 days schedules
• KPS ≥ 70, Age ≥ 30
• Stage I ­ IVA
Grade II Hoarseness in 7 (23%)
• Median duration 58 days
7 field dynamic IMRT with 6 MV photons. Grade II/III Weight loss in 12 (39%)
Entire vol treated with IMRT Grade III Mucositis in 13 (42%)
Biweekly portal imaging done Grade III Dermatitis in 4 (13%)
Toxicity graded using NCI CTCAE v 3.0
scheme
Week wise prevalance of mucositis in
the two schedules

SIB 72 (33#) SIB 60 (30#)

GTV 72 Gy (88 Gy10) 66 Gy (81 Gy10) Median Follow­up 21 months

2 patients absconded during treatment
• Presumed dead due to disease
CTV High Risk 66 Gy (79 Gy10) 60 Gy (72 Gy10)

CTV Low Risk 57 Gy (67 Gy10) 54 Gy (64 Gy10) At last follow­up 29 patients were disease free
2 yr DFS was 93.5% (Median DFS not reached)
• 1 patient died of massive GI bleed
BED calculation done for tumor control without
proliferation correction.

2 yr OS was 89.9% (Median OS not reached)

Univariate testing KPS > 70 associated with better survival
• KPS > 70 Mean OS 31 month
• KPS 70 Mean OS 21 months

Dose gradient across target volume and

contralateral parotid sparing

Representative DVH
for a patient Bar chart showing the percentage of patients with Grade II/III
xerostomia stratified as per follow up duration. At last F/U only 8
Actuarial estimate of duration of patients had Grade II xerostomia Actuarial estimate of duration of
Gr II xerostomia ANY dysphagia

Dosimetric data for the

patient population